Provider Demographics
NPI:1942014253
Name:WONGWATANAVIKROM, NARRAN
Entity type:Individual
Prefix:
First Name:NARRAN
Middle Name:
Last Name:WONGWATANAVIKROM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4369 PACIFICA WAY UNIT 7
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-5778
Mailing Address - Country:US
Mailing Address - Phone:619-859-5955
Mailing Address - Fax:
Practice Address - Street 1:4369 PACIFICA WAY UNIT 7
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-5778
Practice Address - Country:US
Practice Address - Phone:619-859-5955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA97982225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist